Healthcare Provider Details

I. General information

NPI: 1528983327
Provider Name (Legal Business Name): MINDHARBOR THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29532 SOUTHFIELD RD STE 115
SOUTHFIELD MI
48076-2023
US

IV. Provider business mailing address

2510 BELLE VIEW DR
SHELBY TOWNSHIP MI
48316-2927
US

V. Phone/Fax

Practice location:
  • Phone: 248-688-7541
  • Fax:
Mailing address:
  • Phone: 248-688-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. OLESYA TRAN
Title or Position: PRESIDENT
Credential: LLP
Phone: 248-688-7541